Global Projection of Revision Total Hip and Knee Arthroplasty Through 2060: A 17-Country Analysis Using Worldwide Registry Data.

BACKGROUND: The expanding pool of primary hip and knee arthroplasty implants in situ will generate a growing burden of revision arthroplasty. Projections for several individual countries have been published, but heterogeneous methods and time horizons prevent direct aggregation. We used a uniform method to estimate annual revision total hip arthroplasty (rTHA) and revision total knee arthroplasty (rTKA) volumes through 2060 for 17 registry-equipped countries.

METHODS: Annual rTHA and rTKA counts were extracted from each country's most recent register annual report or registry-based publications. Adult (≥25 years) population denominators were taken from the UN World Population Prospects 2024 medium variant. For each country and procedure, we fitted a log-linear Poisson generalized linear model with the year as a covariate and ln(population) as an offset; each fitted trend was partially pooled across countries, bounded at ±2.0% per year, and damped over the projection horizon. Three sensitivity analyses (demographic-only, half-trend Poisson, logistic saturation) were also performed to bracket modeling uncertainty.

RESULTS: In 2024, the modeled 17-country aggregate was 185,921 rTHA and 189,689 rTKA procedures. Under the primary capped Poisson model, the 2060 aggregate reached 243,404 rTHAs and 267,456 rTKAs, corresponding to increases of 31% and 41%, respectively, relative to 2024. Country-level volume trajectories were heterogeneous: the United States and People's Republic of China drove most absolute growth, while Germany, the United Kingdom, and Sweden approached plateaus by mid-century and Japan was projected to have a decline. The 4 projection methods spanned 2060 combined volumes of ⁓461,000 (demographic-only) to ⁓511,000 (primary model) procedures.

CONCLUSIONS: Across 17 countries that perform most of the world's hip and knee arthroplasties, annual revision volumes are projected to grow by approximately one-third (36% in aggregate; 31% for rTHA and 41% for rTKA) by 2060 under the primary model. The United States and China account for the largest absolute growth; mature European systems flatten, and Japan declines. These projections have direct implications for revision-fellowship pipelines, perioperative infection-prevention programs, and registry infrastructure.

LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.